![]() ![]() Improvement was prominent after 3 months and showed a gradual decrease with time. In this study, regardless of the number of treatment shots, physicians' evaluations and patients' satisfaction with the clinical effects of HIFU seemed similar in all areas. This questionnaire also included several questions about the patients' satisfaction after HIFU treatment, their assessment of adverse effects, and their opinions about whether they would like to undergo further HIFU treatment or whether they would recommend HIFU to others. We adjusted the order of the scale to make it easier to understand whether the treatment was effective or not. On the basis of the Global Aesthetic Improvement Scale (GAIS), we subdivided the degree of improvement and satisfaction into five scales in the inverse order of GAIS. Each patient scored their satisfaction in each area of their faces, and also scored their overall satisfaction with their improvement after treatment on a scale of 1 to 5, as follows: 1, not satisfied 2, somewhat satisfied 3, satisfied 4, very satisfied 5, extremely satisfied. In addition, we conducted a survey to assess patient satisfaction and adverse effects. The overall clinical improvement was also assessed. Each facial area was evaluated before treatment and after 3 and 6 months by using the following scale: 0, none 1, mild 2, mild/moderate 3, moderate and 4, severe. To assess the severity of facial wrinkles and skin laxity, we modified the eight-point photographic scale suggested by Chung et al. They divided the face into seven areas (supraorbital, zygomatic, infraorbital, perioral, cheek, preauricular, and jawline, excluding the nose and periorbital areas). The clinical assessment was based on the evaluation of pretreatment and posttreatment photographs by two independent clinicians who were not directly involved in the treatments. Standardized photographs of frontal and 45° angle views, along with profiles from each side, were obtained before, and 3 and 6 months after the treatment. From 400 to 500 shots were delivered according to the size of the face. Each probe delivered a set of pulses in a linear array at 1-cm intervals. ![]() After cleaning the face, a layer of ultrasound gel was applied to the skin. In three patients, we used a nerve block of the supraorbital, supratrochlear, intraorbital, and mental nerves. ![]() Topical lidocaine/prilocaine cream (EMLA cream Astra Pharmaceutical Products Inc., Westborough, MA, USA) was applied under an occlusive dressing for 60 minutes. We used hand pieces that delivered energy at 7.5 MHz and focal depths of 3.0 and 4.5 mm. They were treated with a HIFU tightening device (Ulthera system Ulthera Inc., Mesa, AZ, USA) to the entire face, except for the nose and eyes, by using the following probes: 4 MHz, 4.5-mm focal depth 7 MHz, 4.5-mm focal depth and 7 MHz, 3.0-mm focal depth. The patients' ages ranged from 37 to 75 years (mean, 52.3 years). Informed consent was obtained from all patients, consisting of 18 women and 2 men. All patients were of Fitzpatrick skin types III and IV. Twenty patients with facial wrinkles and skin laxity were enrolled in the study. The principle of HIFU is to induce cellular damage and volume reduction of the target area selectively by means of coagulation by generating instant microthermal lesions through the accumulation of high-frequency ultrasound beams at the specific tissue site without any damage to the epidermis and adjacent issue 11. Currently, it is being used for facial rejuvenation, lifting, tightening, and body contouring, which are considered 'off-label' use 8 9 10. 7 reported the first dermatologic, aesthetic use of HIFU in 2008, and HIFU was approved by the Food and Drug Administration in 2009 for use in browlifting. High-intensity focused ultrasound (HIFU) may be the best example of this technique. Recently, ultrasound was introduced as a new treatment for therapeutic and cosmetic purposes 5 6. In response to this problem, various treatments, including chemical peeling, microdermabrasion, fractional laser, and radiofrequency, have been proposed for the treatment of facial wrinkles and laxity however, the ideal treatment option has yet to be identified 1 2 3 4. Recently, there has been increasing public concern about facial wrinkles and loss of elasticity due to aging. ![]()
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